Treating domestic abusers still a rare niche


Henry R. Lesieur, Psy.D., is staff psychologist at Rhode Island Hospital. He counsels couples involved in domestic violence situations with a supplementary gambling component. (photo by Kathryn Hardy)

By Phyllis Hanlon

After Leonore E. Walker, Ed.D., coined the phrase "battered woman's syndrome" in 1979, law enforcement and social service agencies began to scrutinize the issue of domestic violence. Although the number of psychologists who specialize in this field is still relatively low, the severity of the issue begs the attention of mental health care providers.

In 1977, David Adams, Ed.D., co-founded and co-directs EMERGE, in Cambridge, Mass., the first intervention program in the country for men who batter. Driven by a need for power and control, batterers seek to dominate partners emotionally, financially, sexually, psychologically and physically, he reports. Underlying reasons for the need to control vary, but a leading, although not foolproof, predictor of who may become an abuser lies in childhood experience. If a boy grew up with a father abusive to his mother, he tends to repeat the same behavior when he becomes an adult, Adams says.

Armed with this data, Adams helped develop the 40-week program that currently treats 250 men weekly, half of whom are court-referred, another one-third, voluntary attendees and the remaining, men who have exposed their children to domestic violence and are sent by the Department of Social Services (DSS), according to Adams.

Participants meet in two-hour sessions divided into two phases. "In the first phase, the program broadens their understanding of domestic abuse. They think any illegal act is abuse - such as hitting, grabbing and punching - but there's more to it," Adams says. Individuals are taught how their violent behavior also affects them personally, as well as their spouses and children.

Much of the real work is accomplished in phase two as individual interventions are created through interactive group dialogue, according to Adams. "We try to have them recognize any patterns and create individual goals," he says. "We then give them alternatives and skills for avoiding this type of behavior." Progress requires recognition of the problem and long-term commitment to improve the situation.

Initial resentment presents a challenge, but Adams says that a significant number of men eventually recognize the program's benefits. "They see that they can have successful and better relationships," he says. "A lot of what batterers do is externalize. We try to have them recognize that they've created a dynamic. They have to recognize their own controlling behavior and replace it with more respectful ways."

At the UMass Memorial Medical Center, University Campus in Worcester, Lynn Dowd, Psy.D. directs similar programs - men's and women's anger management programs - that began as a research project for batterers. She finds that most attendees have been perpetrators, as well as victims at some time in their lives and says that many have suffered a background of neglect and abuse as children and share similar traits.

"They are impulsive. They don't think and reflect. Many are not well educated. The majority work in low socioeconomic positions," she says. "Some people never had models for how to express anger in a modulated way. They have habits of jumping to conclusions, over-exaggerating. They see things in black and white." Add to this profile, anxiety, mood disorders, posttraumatic stress disorder and substance abuse and you have a perfect recipe for an inability to control emotions, Dowd says.

The UMass program attempts to raise awareness and prompt individuals to notice their inner physiological reactions to stress. "We want them to notice how quickly they short-circuit when they could delay reacting or choose a different course of action," Dowd says. By instructing individuals in the range of emotions associated with anger through videos, discussions and learning exercises as well as interactive group conversation, this program aims to cultivate introspection and teach developmental processes.

Laurence Bart, Ph.D., is staff psychologist at the Anna Marsh Behavioral Care Clinic at the Brattleboro Retreat in Vermont and director of forensic services. He conducts therapy sessions for couples involved in domestic violence but initially treats each partner as an individual. "If you interview separately at the beginning, you can hear the part of the truth they would rather not say or feel safe saying in front of their spouse," he says.

In the absence of severely violent situations, Bart facilitates negotiation skills training to achieve a balance of parity and power. If, however, a significant risk of hospitalization exists, he pursues different tactics that vary according to each couple's needs. "If there's severe violence, the couple would be happier in individual therapy for a while and only doing treatment together when there's some reason to believe there is self-control," he says. Further, he indicates that couples therapy could be counter-productive if the individuals are unable to modulate their emotions. "Couples have to titrate emotionality and process it so it stays within the therapeutic range," Bart says.

Henry R. Lesieur, Psy.D., Ph.D., staff psychologist at Rhode Island Hospital, counsels couples involved in domestically violent situations with a supplementary gambling component. He utilizes cognitive behavioral therapy, diaphragmatic breathing and relaxation techniques in his course of treatment. "I teach the biology of anger and how this is different than their perceptions," Lesieur says. "A good anger management program ferrets out depression or bipolar disorder," he says. He notes that any emotional ailment may require psychopharmacological therapy before an effective abuse prevention program can be initiated.

Cultural considerations also influence domestic violence treatment methods. Dowd says, "Immigrants might use disciplinary measures accepted in other countries. Here, the Department of Social Services (DSS) takes a dim view of this behavior." EMERGE formed groups to treat Hispanic, Vietnamese, Cambodian and African-American men. "We believe in creating culturally relevant intervention," Adams says. "Each group has its own strengths and weaknesses. We work to create buy-in and trust from those groups."

Available domestic violence data can be confusing. "As a culture, we tend to think mostly men commit domestic violence crimes," Dowd says, "but these statistics come from the emergency room and criminal justice reports. Primarily, women are reporting injuries, but look at [the results of] family violence surveys." These randomized surveys provide data from 10,000 households and reveal that aggressors are more evenly distributed between men and women, although males cause more injuries.

In spite of a serious need, Adams notes the dearth of psychologists who treat domestic violence issues. "This has been a neglected area," he says. When he received his doctorate, there was no coursework in domestic violence. EMERGE now offers domestic violence training. "We get 20 psychologists a year who take our training," says Adams, a small number in proportion to the psychologists in practice.

Treating domestic abusers still a rare niche (June 2004 Issue)

Treating domestic abusers still a rare niche
(June 2004 Issue)